TRIAGE SCENARIOS• Justifying and Assigning Triage Scores
Scenario 1• Violet is a 91 year old female of non-English speaking background. She is brought to the hospital in her son’s car after seeing the local doctor in the next town. You are called to assist her to get out of the car. Her son tells you she is “very sick”. You note that she is able to transfer to a wheelchair with minimal assistance. According to her son, Violet fell three days earlier and has bruised her right hip. She is able to walk, though her hip is very painful. She is not distressed when seated. Her blood pressure is 150/90, heart rate 88 and respiratory rate 20. You are unable to ascertain her exact level of pain, though she tells you she is alright.• Triage score?• Reasons?
Scenario 1• Violet• Triage Score 4• Airway, breathing and circulation intact.• Hip causing pain on movement but able to weight-bear.• Should wait no longer than 60 minutes
Scenario 2• A father presents to the hospital at 2000hrs with his three and a half year old daughter, Savannah, stating that she has had a sore throat for “a day or two”. It started with a runny nose and a fever, then yesterday she began complaining of a sore throat. She has no cough or stridor, she demonstrates no shortness of breath and her skin is pink and warm.• Triage score?• Reason?
Scenario 2• Savannah• Triage Score 4• Airway, breathing and circulation are intact• She is experiencing some discomfort from her condition and should commence treatment within 60 minutes.
Scenario 3• Nic, a 38 year old arborist, has cut his left arm with a chain saw. He was brought into the hospital by a workmate. He has a deep laceration of about 10cm to the inner aspect of his arm. The wound was bleeding “quite a bit” but the blood loss has been controlled with firm bandaging. He tells you that the wound is “not that painful” but he looks pale and is sweating. His heart rate is 84 and his respiratory rate 20. His workmate reports that the dressing was changed once, half an hour ago because it was soaked with blood.• Triage score?• Reasons?
Scenario 3• Nic• Triage Score 3• Airway and breathing are intact, no haemodynamic compromise despite moderate blood loss• This patient should wait no longer than 30 minutes before treatment is commenced• A clean dressing and firm bandage should be applied to the wound. A sling should be applied and elevation of the arm should occur• Retriaging will be required if haemodynamic compromise or increased blood loss occur
Scenario 4• Heidi, a 17 year old female, presents to the hospital complaining if a sore throat. She has a hoarse voice and her friend states that she has had muscular pain to her neck, shoulders and back. She has been unwell for a few days, but has come to the hospital today because she is having trouble swallowing. You ask her to open her mouth and note that her breath is foul-smelling. Her tonsils appear to be covered in pus. Her temperature is 39.4 C.• Triage score?• Reason?
Scenario 4• Heidi• Triage Score 3• Airway, breathing and circulation intact.• Patient is septic and treatment should commence within 30 minutes
Scenario 5• Liam is a 23 year old male who presents to the hospital after seeing a locum doctor. He is backpacking around Australia and has been stating in a boarding house near the hospital. His partner has brought him to the emergency department. He has a 6 hour history of fever and lethargy. He has been vomiting, and complains of a headache. The doctor gave him IM Maxalon, it has had some effect. His temperature is 38.4°C, and his partner points out a fine petechial looking rash n his torso. He is drowsy but orientated to time, place and person.• Triage score?• Reason?
Scenario 5• Liam• Triage Score 2• Airway, breathing and circulation are intact• The patient has signs of meningococcaemia and needs to commence treatment within 10 minutes
Scenario 6• Baz, 34 years old, was installing a ceiling fan with the assistance of a friend in his own home. He received a 240 volt charge to his right hand, and was thrown back against the roof. His friend immediately switched off the power and called an ambulance. Baz had a brief period of loss of consciousness, but was alert when the ambulance crew arrived. His heart rate is 80 and irregular and his respirations 20. He has a 5 cm blackened area to his right hand. No exit wound is seen.• Triage score?• Reasons?
Scenario 6• Baz• Triage Score 2• Airway, breathing and circulation are intact• Likely full thickness burn from electrocution indicates severe local trauma with possible systemic involvement• Should wait no longer than 10 minutes for treatment
Scenario 7• Hannah is a 41 year old woman who presents via ambulance with n altered conscious state following collapse. She is 30 weeks pregnant (G3 P1) and is normally well. She was out shopping with a friend when she suddenly collapsed. Ambulance officers report a fluctuating conscious state. At the scene she tolerated an oropharyngeal airway but spat it out on route. She is in a lateral position on the ambulance trolley with supplemental oxygen via mask. Her respiratory rate is 10; her SaO2 is 93% and heart rate 130. her BP is 190/110 her Glasgow Coma score is 10 out of 15. her temperature 36.3°C.• Triage score?• Reason?
Scenario 7• Hannah• Triage Score 1• Airway may be compromised due to fluctuating level of consciousness. There is additional risk to her airway and breathing due to pregnancy. There is hypoventilation and severe hypertension. There is imminent risk of deterioration.• Simultaneous assessment and treatment must commence immediately
Scenario 8• Hugh is a 54 year old male who was seen in the emergency department with a fractured right radius and ulna 4 days ago. He presents again because he says his cast is too loose and needs to be replaced. He has no pain.• Triage score?• Reasons?
Scenario 8• Hugh• Triage Score 5• This is a non urgent problem. However the plaster needs to be assessed as it was applied in the emergency department and if it is loose will not effectively immobilize the fracture
Scenario 9• A mother presents with her six month old baby Rebecca, who she says will not wake up. The child is breathing, but is floppy, cannot be roused and has pinpoint pupils.• Triage score?• Reasons?
Scenario 9• Rebecca• Triage Score 1• Airway is unstable and cardiac arrest is imminent.• The child requires simultaneous assessment and treatment
Scenario 10• Antony, 56 years, was opening a tin of paint stripper with a knife and some of the chemical splashed up into his right eye. He ran water from the tap over his eye for fifteen minutes, before his partner drove him to hospital. At triage he appears very uncomfortable; the eye is closed and there is blistering to the skin surrounding the right orbit.• Triage score?• Reasons?
Scenario 10• Antony• Triage Score 2• Airway, breathing and circulation are clear.• There is chemical burn to the eye with changed visual acuity• This patient should receive treatment within 10 minutes
Scenario 11• Bluey, a solidly built male about 40 years of age and smelling strongly of alcohol starts shouting at another patient whilst sitting in the waiting room. He says he wants to see a doctor, but before you can establish what is wrong, he stands up and begins to threaten with a knife the other patients who are waiting.• Triage score?• Reason?
Scenario 11• Bluey• Triage Score 1• Immediate threat of physical violence using a weapon• Simultaneous security and clinical response to aggression is required immediately
Scenario 12• Justin is a 22 year old male who comes to the hospital concerned about a mole on his back. He says that his girlfriend advised him to see a doctor and he is worried that “it might be a melanoma”. The mole is large and irregular in shape; he says it is itchy.• Triage score?• Reasons?
Scenario 12• Justin• Triage Score 5• Airway, breathing and circulation are intact• This is not an urgent problem, however the lesion needs to be checked for melanoma and this should occur within two hours